Frequency of and Predictive Factors for Vascular Invasion after Radiofrequency Ablation for Hepatocellular Carcinoma

Abstract

BackgroundVascular invasion in patients with hepatocellular carcinoma (HCC) is representative of advanced disease with an extremely poor prognosis. The detailed course of its development has not been fully elucidated.MethodsWe enrolled 1057 consecutive patients with HCC who had been treated with curative intent by radiofrequency ablation (RFA) as an initial therapy from 1999 to 2008 at our department. We analyzed the incidence rate of and predictive factors for vascular invasion. The survival rate after detection of vascular invasion was also analyzed.ResultsDuring a mean follow-up period of 4.5 years, 6075 nodules including primary and recurrent lesions were treated by RFA. Vascular invasion was observed in 97 patients. The rate of vascular invasion associated with site of original RFA procedure was 0.66% on a nodule basis. The incidence rates of vascular invasion on a patient basis at 1, 3, and 5 years were 1.1%, 5.9%, and 10.4%, respectively. Univariate analysis revealed that tumor size, tumor number, alpha-fetoprotein (AFP), des-gamma-carboxy prothrombin (DCP), and Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein were significant risk predictors of vascular invasion. In multivariate analysis, DCP was the most significant predictor for vascular invasion (compared with a DCP of ≤100 mAu/mL, the hazard ratio was 1.95 when DCP was 101–200 mAu/mL and 3.22 when DCP was >200 mAu/mL). The median survival time after development of vascular invasion was only 6 months.ConclusionVascular invasion occurs during the clinical course of patients initially treated with curative intent. High-risk patients may be identified using tumor markers.

Predictive factors of pathological vascular invasion in hepatocellular carcinoma within 3 cm and three nodules without radiological vascular invasion

“…In addition, there were no recognizable local recurrences that could be clearly attributed to the residual tumor at the treatment site. All the patients in this study were treated with hepatic resection, and if they had been treated with local ablation therapy, the prognosis for pathological vascular invasion positive patients might have been poorer than those reported for negative patients . Several previous studies have reported the negative impact of pathological vascular invasion in HCC patients treated with surgical resection .…”

“…The predictive factors for microscopic vascular invasion were evaluated based on age, sex, hepatitis B virus surface antigen (HBsAg), hepatitis C virus antibody (HCVAb), treatment history for HCC, liver damage, tumor number, serum levels of AFP of more than 100 ng/mL, AFP‐L3 of more than 10%, PIVKA‐II of more than 100 mAU/mL, and macroscopic findings. Recurrence‐free and overall survival rates of pathological vascular invasion positive and negative patients were also compared.…”

Intraoperative ultrasound for prediction of hepatocellular carcinoma biological behaviour: Prospective comparison with pathology

“…Also because of these reasons, many factors and scoring systems evaluated by preoperative noninvasive procedures have been proposed to predict MI‐HCC and/or HCC tumour differentiation . A study by Zhao et al demonstrated that serum AFP level >400 ng/L, serum GGT level >130 U/L, total tumour diameter >8 cm and tumour number >3 were identified as independent predictors of vascular microinfiltration, but this retrospective analysis needs a prospective validation.…”

Sharpin promotes hepatocellular carcinoma progression via transactivation of Versican expression

“…2 The 5-year survival rate after vascular invasion development was only 6.4% in our institute. 3 The molecular mechanisms underlying HCC invasion remain ill-defined, hindering the development of novel therapeutic options. Better elucidation of the molecular pathway involved in HCC invasion could facilitate the development of better treatment options for patients.…”